Provider Demographics
NPI:1528726155
Name:CARROLL, JENNA HAYDEN (PMHNP)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:HAYDEN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2255
Mailing Address - Country:US
Mailing Address - Phone:716-257-1254
Mailing Address - Fax:716-215-6170
Practice Address - Street 1:901 WAYNE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2255
Practice Address - Country:US
Practice Address - Phone:716-257-1254
Practice Address - Fax:716-215-6170
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-403943-01363LP0808X
NY774542163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health